SPSO Individual Decisions

C complained that the practice failed to reasonably respond to their complaint. C had made a complaint to the practice about communication and the service provided by them, particularly in relation to their appointment services, phone lines, and frontline staff. C was concerned by the content and tone of the practice’s complaint response. We found that the practice’s handling of C’s complaint was unreasonable, including the tone and language of their response and a failure to signpost to the SPSO. We considered some of the language used in their response came across as overly defensive and failed to maintain an appropriately conciliatory tone. The practice also failed to have an appropriate two-stage complaint procedure in place that follows the NHS Scotland Model Complaints Handling Procedure, as they were unaware this applied to them. Therefore, we upheld C’s complaint.

C complained about the care and treatment their adult child (A) received from the practice. A had undergone surgery to remove infected fluid on the right lung. Gabapentin (an anticonvulsant medication primarily used to treat partial seizures and neuropathic pain) was prescribed to manage nerve pain at the incision site. The practice later stopped prescribing gabapentin and A’s mental health deteriorated significantly. C complained about the abrupt withdrawal of gabapentin. They highlighted that gabapentin had been prescribed to manage ongoing nerve pain following surgery and noted the risks of sudden withdrawal. The practice stated that prior to the discontinuation of gabapentin there had been an increase in early requests for renewal of medication, which caused concern. A had not attended appointments with the GP or with cardiology (specialists in diseases and abnormalities of the heart). The GP felt that they could not justify further prescription of controlled drugs without seeing the patient. We took independent advice from a GP. We found that there was no record of any significant harm from gabapentin or evidence of overuse, or had there been any discussion around reducing or stopping gabapentin. We noted that gabapentin is known to cause problems during the withdrawal period and it should therefore be withdrawn slowly. We also found that no withdrawal support was given. In light of this, we considered that the practice had failed to appropriately manage A’s prescription for gabapentin and upheld C’s complaint. We also found failings in the practice’s handling of C’s complaint.

C complained that the care and treatment they received from the practice was unreasonable. C said that they had developed an intolerance to a number of medications, some of which they had previously tolerated. C sought a referral to pharmacology (the branch of medicine concerned with the uses, effects, and modes of action of drugs) through the practice but complained that they unreasonably failed to facilitate this. C complained that the GPs at the practice were dismissive of C’s symptoms without reasonable investigations being carried out. C said that their symptoms were inappropriately attributed to anxiety or panic attacks and that GPs provided misleading information in referrals that suited their own presumptions about C’s diagnosis. We took independent advice from a GP. We found that, whilst the GPs and C disagreed about the likely cause of C’s symptoms, the GPs did not rule out C’s opinion or block their access to specialist investigations. We were satisfied that the practice’s GPs made referrals based on their assessments of C’s symptoms, but put forward C’s opinion for consideration by the receiving specialists. We were satisfied that the practice’s GPs made appropriate referrals and did not promote their own ideas about C’s likely diagnosis. Whilst we considered that one of the GPs could have communicated more clearly with C about the reasons behind one of the referrals, overall, we found the care and treatment provided by the practice to be reasonable. We did not uphold this complaint. Related reading View Decision Report 201901939 as a PDF (24.44 KB) Updated: October 20, 2021

Ms C complained on behalf of her child (Child A). After being assessed at a gender identity clinic, Child A was diagnosed with transsexualism and it was recommended that they be prescribed Sustanon (a hormone injection). The gender identity clinic wrote to Child A's GP to ask for arrangements to be made for Sustanon to be prescribed and administered. However, the practice advised that they would not prescribe or administer the medication for an initial period. Instead, they considered it appropriate for the gender identity clinic to prescribe the medication and make arrangements for it to be administered until Child A was stabilised, at which point the practice would take over. The practice stated that this decision was due to a lack of professional knowledge in this area and concerns about the GP's indemnity cover as Sustanon is classed as an unlicensed medication for this purpose. Ms C complained that the practice unreasonably declined to prescribe the medication and that they failed to communicate reasonably. Ms C stated that no GPs had been in contact to discuss the situation and there had been a lack of clarity about the practice's decision-making. We took independent advice from an adviser with a background in general practice. We found that General Medical Council guidance supported the practice's position that they should not prescribe medication or initiate treatment if they do not consider themselves professionally competent to do so. We considered it appropriate, and in line with relevant guidance, for the practice to refer the matter back to the gender identity clinic for them to arrange treatment. In addition to this, we were satisfied that the reasons provided by the practice to Ms C were valid considerations for the practice to take into account. Therefore, we did not uphold this aspect of Ms C's complaint. In relation to communication, we considered that it would have been helpful if a GP from the practice contacted Ms C or Child A to disc

Mr C complained about the care and treatment provided to his late mother (Miss  A) by the practice. He complained that the decision to initiate end of life care for Miss A was unreasonable and that she should have been moved to a more appropriate facility for active treatment. We took independent advice from a GP. We found that the decision to commence Miss A on end of life care was reasonable as she was no longer responding to treatment. We further found that it would not have been appropraite to transfer Miss A to a different facility. We did not uphold this aspect of Mr C's complaint. Mr C also raised concerns about the practice's handling of his complaint, as they had declined to release any information to him due to him not being Miss A's recorded next of kin and them having no information regarding his position to make a complaint. We found that whilst it was not unreasonable for the practice to take this position, it would have been helpful for them to acknowledge Mr C's complaint in a timely manner and seek further information from Mr C regarding Miss A's personal representative. We also found that the practice failed to respond to Mr C within 20 working days and did not signpost him to this office. We upheld this aspect of Mr C's complaint.

Ms C complained to us that the medical practice had failed to provide her with appropriate care and treatment when she reported problems with her mobility and that she was not sent for x-rays or scans in order to arrive at a diagnosis. Ms C had subsequently registered at a new practice where the staff quickly identified her problems and arranged x-rays which resulted in her undergoing two hip operations. Ms C felt the previous practice should have addressed her mobility problems a number of years ago. We took independent advice from a GP adviser. We found that the practice had provided a reasonable level of care. When Ms C reported hip pain, she had x-rays taken and was referred for physiotherapy and provided with painkillers. From then until Ms C left the practice, we found that she did not report any additional symptoms or that her pain had deteriorated or worsened and, as a result, there was no requirement for the practice to undertake further investigations. We did not uphold the complaint. Related reading View Decision Report 201706382 as a PDF (11.11 KB) Updated: December 2, 2018

Mrs C complained that GPs at the medical practice failed to diagnose cholesteatoma (an uncommon abnormal collection of skin cells inside the ear). Mrs C felt the practice had failed to do this over a number of years. We took independent advice from a GP adviser. We found there was no evidence that Mrs C's consultations with GPs several years ago were linked to her recent consultations in terms of cholesteatoma diagnosis. We also found that the practice's management of Mrs C's case was reasonable during all consultations, and when they noted that her symptoms were not settling they arranged an urgent review with a hospital specialist. There was no evidence of a delay in the referral and we concluded that the care provided to Mrs C was to a reasonable standard given the circumstances at the time. Therefore we did not uphold Mrs C's complaint. Related reading View Decision Report 201601281 as a PDF (11.01 KB) Updated: March 13, 2018

Mrs C's father (Mr A) was treated with radiotherapy for cancer of the tongue. In the 18 months following his treatment, Mr A received ongoing support from community dieticians and speech and language therapy (SALT), and regular reviews at a joint cancer clinic. During this period, Mr A had increasing difficulty swallowing and suffered from recurrent mouth ulcers and pain. He also had several short hospital admissions with bleeding from the mouth. In June 2014 Mr A was referred back to hospital with weight loss, decreased ability to swallow and stridor (noisy breathing caused by a narrowed or obstructed airway). He underwent endo-tracheal intubation (insertion of a tube to maintain an open airway to the lungs) and was transferred to a different hospital. Mr A passed away about ten days later. Mrs C complained about the care provided by the practice during this period. She said Mr A's family constantly raised concerns about his weight loss, increasing pain and frailty, but these were not listened to. She said the practice often phoned Mr A (instead of arranging face-to-face appointments) and did not adequately monitor his weight loss and malnutrition. Mrs C was also concerned that the practice did not provide adequate care for Mr A's emotional wellbeing or diagnose him with depression. In addition, Mrs C said the practice refused to refer Mr A back to hospital in late May 2014, and the admission was only arranged when her sister called the specialist nurse directly a few days later. After taking independent advice from a GP, we did not uphold Mrs C's complaints. We found that the practice provided reasonable care during this period, including responding to Mr A's symptoms (and the adviser noted that many of Mr A's symptoms related to his recent cancer treatment, for which he was receiving specialist care). In relation to emotional support, the adviser said the records did not show any symptoms that should have prompted a diagnosis of clinical depression, a

Mrs C's mother (Mrs A) is 92 years old. Mrs C complained about the length of time that her mother had to wait for a flu vaccination. Mrs A had requested a home visit for the vaccination and initially the medical practice had refused, saying that their policy was that only housebound patients were entitled to this. However, they then changed their mind and passed the request to district nursing staff to arrange. After a few days, Mrs A had received no contact from either the practice or the district nurses. She contacted the practice and was given a surgery appointment, where the vaccination was administered. The practice confirmed to us that their policy was that only housebound patients were given a home visit for this, but that they had made an exception in Mrs A's case. District nurses had to prioritise flu vaccinations, and gave clinical priority to housebound patients and those in residential homes or sheltered housing complexes. The practice explained that Mrs A would have received the flu vaccination at home by the end of the month in which she got it, in line with their guidelines. We took independent advice on this from one of our medical advisers, who confirmed that the practice's actions were appropriate. He had no concerns that the home visit was not carried out earlier or that the priority afforded to the request was unreasonable, and we found no evidence of any avoidable delays in dealing with Mrs A's request. Related reading View Decision Report 201303595 as a PDF (11.29 KB) Updated: March 13, 2018

Mr C complained that the medical practice had acted unreasonably in refusing him a repeat prescription for an inhaler. He had made a repeat prescription request, but this was refused and he was told to attend an asthma review clinic two weeks later. He was unhappy that he had not been given his medication at the time he needed it, which he felt was a risk to his health. The practice's response to Mr C indicated that before he made the prescription request he had been sent four letters inviting him to attend the asthma clinic but he had not gone. The prescription record also showed that Mr C was not using his inhaler regularly. They had, therefore, felt unable to issue the prescription until he had complied with their requests for an asthma review. They said they had a clinical, ethical and legal responsibility to review his medication and clinical condition before issuing a prescription. They offered him the opportunity to have the review undertaken in a manner and at a time which suited him, and to refer him to a respiratory specialist. We took advice from our medical adviser, who considered Mr C's medical records. He said that treatment cannot be given without reasonable and correct supervision, and that the practice had given Mr C various opportunities to attend for the review. Given the pattern of inhaler use, he also considered that such a review would be good clinical practice. We concluded that the practice did not act unreasonably, and did not uphold the complaint. Related reading View Decision Report 201105352 as a PDF (11.4 KB) Updated: March 13, 2018